<p>Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the '''Health Services Division''' under the Department of Corporations.</p><br>

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<p>Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the '''Department of Managed Health Care'''.</p><br>

Revision as of 22:44, 30 May 2013

HEALTH BENEFITS PROGRAM (TYPES)

Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the Department of Managed Health Care.

Point-of-Service (POS)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMO's, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Insurance.

Preferred Provider Organization (PPO)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMOs, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Insurance.